ATLANTA--The economic cost of HIV/AIDS is far greater than previously estimated, and the cost is even higher for minorities, according to a new study that estimated the direct and indirect costs of the disease. The total lifetime cost of illness for Americans newly diagnosed with HIV in 2002 is approximately $36.4 billion, of which more than 80 percent is related to productivity losses, a cost that most previous studies have omitted. The study also reveals that while the direct costs of antiretroviral therapy may be high, these costs are eventually offset by extended productivity. The research shows that differences in medical care result in dissimilar costs -- both direct and indirect -- among different racial and ethnic groups.

The study is published on-line in the Journal of Acquired Immune Deficiency Syndromes (JAIDS), ahead of print publication. It is the result of collaboration among researchers at the Centers for Disease Control and Prevention (CDC), the Emory University Center for AIDS Research, and the Andrew Young School of Policy Studies at Georgia State University.

An estimated 40,000 people in the United States become infected with HIV each year. While researchers have previously estimated the economic costs of HIV/AIDS, they have focused primarily on the direct medical expenses of treating the disease. The results up to now have given an incomplete picture of the disease's economic consequences, according to Angela Blair Hutchinson, PhD, MPH, a health economist at the CDC and lead author of the paper.

"We wanted to assess the economic burden of an HIV infection in the U.S.," says Dr. Hutchinson, "by examining the impact of stage of disease at diagnosis and access to treatment on the cost of HIV infection and how this might differ by race/ethnicity."

The research shows that differences in medical care result in dissimilar costs--both direct and indirect Ð for various racial/ethnic groups. "We found that direct costs were lower and productivity losses were higher for minorities," says Dr. Hutchinson.

Specifically, minorities incur fewer direct medical costs than whites ($160,400 for blacks on average, compared with $180,900 for whites), but suffer greater financial damage from lost productivity ($838,000 for Hispanics and $766,800 for blacks on average, compared with $661,100 for whites).

The differences, according to Hutchinson, reflect disparities in treatment. Minorities are, on average, diagnosed at later stages of the disease than whites. In addition, whites with HIV/AIDS are more likely to receive antiretroviral therapy (ART).

As Dr. Hutchinson notes, "ART is not used universally because it is expensive. Many patients with HIV/AIDS do not have health insurance and/or do not have access to ART."

Though ART is costly, it has proven very effective at extending lives, and productivity. The researchers found that ART patients have direct medical costs averaging $230,044, with a projected life expectancy of 24.4 years. Patients not receiving ART have direct medical costs of approximately $114,938, with a projected life expectancy of 12.4 years.

The additional years of productivity after being treated with ART mean that the more expensive treatment is actually more cost effective in the long run. "Universal access to treatment would be cost saving," says Dr. Paul Farnham, a co-author and economist from the Andrew Young School of Policy Studies at Georgia State University, "because it decreases the years of life lost from the illness, and thus lowers productivity losses more than it increases the direct medical costs."

Besides recommending such universal access, the paper also emphasizes the importance of diagnosing the disease early. As Dr. Hutchinson explains, in order to narrow the treatment divide and expense gap among racial/ethnic groups with HIV/AIDS, "There needs to be a focus on earlier diagnosis, particularly for minorities."